(Philadelphia, PA) - Infertility prevents roughly 6.1 million people
in the United States from having children. As a result, infertile individuals
and couples commonly seek to become parents through assisted reproductive
technology (ART). Since 1981, approximately 177,000 babies have been born
via ART: and, in one year alone (2000), some 100,000 cycles of ART were
attempted, resulting in 60,253 live births. Beyond the factors of infertility
and a candidate’s ability to afford treatment, little is known about
the qualifications that ART programs use to determine a candidate’s
eligibility for parenthood. This raises the question: Should there be
guidelines to determine who should be eligible to use this technology
for reproduction?

A new study sponsored by the Center for Bioethics at
the University of Pennsylvania School of Medicine sheds
important light on the values that govern access to ART. The study, published
in the January 2005 issue of the journal Fertility and Sterility,
reveals an alarming inconsistency in the candidate-screening practices
of different ART programs in the United States. Indeed, “the majority
of programs in the U.S. do not have a formal policy for screening, leaving
individual clinics and programs to set their own boundaries” says
Andrea Gurmankin, PhD, principal investigator for the
study, which was completed while Gurmankin was still a member of Penn’s
faculty: she has since joined the Harvard School of Public Health, where
she now serves as Assistant Professor in the Department of Society, Human
Development and Health. By contrast, many countries, such as the United
Kingdom, have national or professional guidelines for screening program
candidates.
According to the researchers, the important role played by clinics in
controlling access to ART in the U.S. emphasizes the need to more openly
discuss and, in turn, establish ART candidate-screening qualifications
to ensure equality across different programs.

The study also revealed that “… the majority of the ART programs
believe that they have the right and responsibility to screen candidates
before providing them with assisted reproductive technologies to conceive
a child… the key value being that they ensure a prospective child’s
safety and welfare and not risk the welfare of the prospective mother.”

The study also found that there was a significant variation across programs
in their reported likelihood of turning away candidates. The researchers
found, for instance, that when program directors were addressed with a
hypothetical situation in which the prospective “mom” in a
couple was addicted to marijuana, 33% of the programs said they would
accept the couple for ART services, whereas 47% of programs would have
denied that couple access. The researchers also found that a couple on
welfare is as likely to be granted access as they are to be denied. “The
frequency of these variations highlight the need for a formal policy and
common guidelines for candidate screening utilized by all ART facilities,”
states co-author Arthur Caplan, PhD, Chair of the Department
of Medical Ethics at Penn’s School of Medicine.

The study began in 2001 when a six-member expert panel -- which included
infertility specialists, an obstetrician/gynecologist, bioethicists, and
a clinical psychologist from an ART clinic -- developed a survey and refined
it into a final questionnaire. A total of 210 out of 369 ART program directors
responded to the anonymous, self-administered, mailed questionnaire.

In addition to Drs. Gurmankin and Caplan, the research team included
Andrea Braverman, PhD, from the Woman’s Institute
for Fertility, Endocrinology and Menopause, in Philadelphia.

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